Heart-study subjects returning to Oakland for 30-year follow-up

Heart-study subjects returning to Oakland for 30-year...

1of4Shakir Zaid observes the monitor during his echocardiogram for the Cardia heart research at Kaiser Permanente Medical Center in Oakland, Calif. on Thursday, Jan. 28, 2016. The on-going project has been tracking the heart health of 5,000 participants nationwide for the past 30-years.Photo: Paul Chinn, The Chronicle

2of4Blood samples were drawn from Robert Francis of Napa, who was recruited for the study when he lived in Alabama.Photo: Paul Chinn, The Chronicle

3of4Colanda Mitchell interviews Shakir Zaid before measuring his blood pressure for the Cardia heart research at Kaiser Permanente Medical Center in Oakland, Calif. on Thursday, Jan. 28, 2016. The on-going project has been tracking the heart health of 5,000 participants nationwide for the past 30-years.Photo: Paul Chinn, The Chronicle

4of4Colanda Mitchell measures Shakir Zaid's height for the Cardia heart research at Kaiser Permanente Medical Center in Oakland, Calif. on Thursday, Jan. 28, 2016. The on-going project has been tracking the heart health of 5,000 participants nationwide for the past 30-years.Photo: Paul Chinn, The Chronicle

Shakir Zaid was 24, married without children and living in Oakland, weighed about 175 pounds and had a full head of hair when he agreed to take part in a national study comparing the risk of heart disease in African American and white men and women.

“I didn’t think they’d still be studying me 30 years later,” said Zaid, 54, the bald-headed pastor who over the past three decades has become the father of eight, finished his doctorate, seen his weight fluctuate by as much as 100 pounds and survived two heart attacks in one day.

Late last month, Kaiser Permanente flew Zaid from his home in North Carolina to Oakland to participate in a four-hour battery of tests as part of the continuing study. He’s one of 5,115 participants who began the study in the mid ’80s at Oakland’s Kaiser hospital, the University of Alabama at Birmingham, the University of Minnesota in Minneapolis or Chicago’s Northwestern University.

A lot has changed since then. Even the study’s name — Coronary Artery Risk Development in Young Adults, or Cardia for short — hasn’t stood the test of time, considering its participants, who were 18 to 30 years old at the start, are now middle-aged or entering their golden years.

9th follow-up exam

Researchers expect to test about 3,445 of the original participants this round, the ninth follow-up examination. They estimate about 6 percent of the participants have died. About 28 percent have dropped out, couldn’t be reached or aren’t expected to participate any longer for other reasons. In Oakland, researchers plan to test about 1,000 of Kaiser’s 1,400 original participants.

Participants are put through a battery of tests generally every five years, with some follow-ups in between. The tests have varied each time, but include measurements for blood pressure, lipids and weight, along with general health questionnaires. Other tests have included a treadmill, pulmonary function, echocardiogram, brain MRI, genetic sampling and, more recently, cognitive function.

So far, the effort at the four sites has produced more than 600 studies, along with a number of sobering statistics. They have given insights into how physical activity and television-viewing habits affect cognitive function later in life, whether marijuana use increases the risk of diabetes and established an association between education and cardiovascular disease.

Up 30 pounds in 20 years

At the 20-year follow-up, when the participants were 38 to 50 years old, the average weight gain was 30 to 35 pounds, and 18 percent of the volunteers already had calcification of the coronary arteries, an early sign of heart disease. In the first 20 years, 26 black participants were diagnosed with heart failure, while only one white patient was.

He said a study designed to look at heart health differences between two races, and involving women as well, was novel for its time.

Sidney, who has been involved in the study since its inception, said the participants have helped add a wealth of data to the science behind understanding who is most at risk for heart disease and why, though those answers are still evolving.

“The most important message of this study, from my understanding, is maybe one of the simplest: What you do and how you manage your health when you’re young makes a huge difference in what happens to you later on,” Sidney said. “It’s adding science behind that. It’s a lot more powerful than relying on common sense.”

Rob Francis breathes into a pulmonary tube for the Cardia heart research at Kaiser Permanente Medical Center in Oakland, Calif. on Thursday, Jan. 28, 2016. The on-going project has been tracking the heart health of 5,000 participants nationwide for the past 30-years.

Photo: Paul Chinn, The Chronicle

Benefits of testing

While the tests produce a large repository of detailed health data, they also provide individuals with information about their own health. For example, Sidney said, a serious blood disease was caught early in a participant whose blood tests showed high levels of platelets, or cells that help the blood to clot.

Zaid, an African American who has participated in all but two follow-up studies, said he’s always shocked by some of his results, such as his weight and high blood pressure readings.

The second of 14 siblings, Zaid said his parents both lived to age 88. But various stresses such as having his own ministry, running a nonprofit and raising eight adopted kids (he prefers the term “chosen out of love”) while neglecting his health nearly cost him his life.

Two years after suffering two heart attacks on Jan. 31, 2011, he moved from the Bay Area to Charlotte, N.C., with his wife and younger children and is working with a nutritionist and a personal trainer to lose weight and get in shape.

“I’m going to be 70 when the youngest turns 18, so I really had to get a personal trainer,” he said between tests. “Next time, I’m not wearing my shirt so I can show off my six-pack. And I’m going to be wearing skinny jeans.”

Study participant Robert Francis was 23, working at his first job in Birmingham when he was recruited to participate in the study by the University of Alabama. Francis, who is white, doesn’t remember how the researchers got his name, but was happy to participate.

Won’t ‘cram’ for exam

Now 53, he’s been married nearly 30 years, raised four kids and in 2004 moved from Alabama to Napa, where he is the chief operating officer for a medical malpractice insurance company. Fortunately for him, his trim weight and overall good health haven’t changed much.

Francis, who’s never missed an exam, said he’s resisted the urge to “cram” for the Cardia tests by changing his diet or exercise habits. But Francis, who admits to not participating in regular exercise, said in recent weeks he started CrossFit, a popular strength and conditioning program.

“It is telling because you do see things change,” he said. “I am getting older. I’m over 50 so I have joints that ache. Different joints every morning.”

Like other participants, Francis said he appreciated undergoing the tests because they make physicals unnecessary and give him more information anyway.

For Wanda Johnson of Oakland, participating in the study was even more personal.

An African American, Johnson was 27 and newly minted registered nurse when she was recruited into the Cardia study by Kaiser. Because distrust of the medical system has caused many black Americans to avoid participating in clinical research, Johnson wanted to be part of the study. She also wanted to learn more about her personal health risks because both her parents had high blood pressure, and her grandmother was diagnosed with congestive heart failure.

While she may have started to exercise regularly in part due to the study and her profession, it’s now just part of her daily routine. The married mother of three who is finishing a doctorate in public health has never missed a study.

Short-term funding

The study has received $143 million in funding from the National Heart, Lung and Blood Institute since its inception, and is funded only through the end of the year. After that, the future is unclear but the researchers point out that funding for Cardia has been short-term and tenuous throughout its history.

Johnson, now 58, said she hopes to be studied for at least another 30 years. “I’ll stick it out as long as I can,” she said. “If they invite me back, I’ll be there.”

Victoria Colliver has been writing about health for the San Francisco Chronicle since 2001, focusing on the health care industry, health policy and cancer. Before joining The Chronicle, she worked for the San Francisco Examiner, the Oakland Tribune and the Stockton Record.

A graduate of UC Davis, Colliver received a master's degree in journalism from Columbia University.